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President Trump, advisor @SWAtlasHoover arguing there& #39;s lot of false coding of COVID
This is junk news
Like junk food, junk news tastes good but has no nutritional value
So what are the facts?
Don& #39;t hospitals get more $ for COVID?
Thread on hospital billing, COVID, and fraud
This is junk news
Like junk food, junk news tastes good but has no nutritional value
So what are the facts?
Don& #39;t hospitals get more $ for COVID?
Thread on hospital billing, COVID, and fraud
Our payment system is insanely complex
So this is a simplification
Hospitals get paid based on what condition patient has
A patient with pneumonia?
Typical hospital might get between $8K to $11K from Medicare, depending on whether pt has major comorbid conditions or not
2/n
So this is a simplification
Hospitals get paid based on what condition patient has
A patient with pneumonia?
Typical hospital might get between $8K to $11K from Medicare, depending on whether pt has major comorbid conditions or not
2/n
So what happened in COVID era?
Cares Act gives hospitals a 20% bump (to about $9600 – 13K) if pneumonia is from COVID
Additional $1600 - $2200 for a typical COVID pneumonia patient
To get this bump, hospitals must document that patient is COVID positive
3/n
Cares Act gives hospitals a 20% bump (to about $9600 – 13K) if pneumonia is from COVID
Additional $1600 - $2200 for a typical COVID pneumonia patient
To get this bump, hospitals must document that patient is COVID positive
3/n
Don& #39;t incentives change billing practices?
Why yes!
Hospitals famous for documenting comorbidities to get higher reimbursement
What folks DON’T do is make up false diagnoses
That& #39;ll get them fined, jailed
Most Docs, hospitals would NOT lie about a positive COVID test
4/n
Why yes!
Hospitals famous for documenting comorbidities to get higher reimbursement
What folks DON’T do is make up false diagnoses
That& #39;ll get them fined, jailed
Most Docs, hospitals would NOT lie about a positive COVID test
4/n
But may be extra $2K might lead hospitals to test their pneumonia patients for COVID?
Actually, even without incentives, any hospitalized patient with pneumonia today will get tested for SARS-CoV2
And if positive, they have COVID
Which gets us to another trope....
5/n
Actually, even without incentives, any hospitalized patient with pneumonia today will get tested for SARS-CoV2
And if positive, they have COVID
Which gets us to another trope....
5/n
Another trope is that someone died "with" COVID, not "because of" COVID.
This is clinical nonsense
If you have pneumonia and are COVID positive?
You have COVID pneumonia. You are sick from COVID
Ah, what about the stories of car accident victims who tested + for COVID?
6/n
This is clinical nonsense
If you have pneumonia and are COVID positive?
You have COVID pneumonia. You are sick from COVID
Ah, what about the stories of car accident victims who tested + for COVID?
6/n
More nonsense
There is no higher reimbursement that I can find for car accident victims who are COVID+.
And if you bill these patients as COVID pneumonia, that& #39;s fraud
This is Facebook junk
Why did Congress, President enact a law that gives hospitals extra $ for COVID?
7/n
There is no higher reimbursement that I can find for car accident victims who are COVID+.
And if you bill these patients as COVID pneumonia, that& #39;s fraud
This is Facebook junk
Why did Congress, President enact a law that gives hospitals extra $ for COVID?
7/n
Higher payment for COVID because policymakers knew hospitals would need extra money getting PPEs.
The federal govt wasn& #39;t going to get PPEs
This was a way to help make hospitals whole
And it hasn’t.
Most hospitals are bleeding money from COVID
8/10
The federal govt wasn& #39;t going to get PPEs
This was a way to help make hospitals whole
And it hasn’t.
Most hospitals are bleeding money from COVID
8/10
What about stories of $40K for a COVID death?
That& #39;s MS-DRG 207: pneumonia patient who spends >4 days in ICU on ventilator
Without COVID, Medicare pays about $35K. With COVID, about 40K
Again, doctors aren& #39;t taking random deaths, calling them COVID deaths
That& #39;s fraud
9/10
That& #39;s MS-DRG 207: pneumonia patient who spends >4 days in ICU on ventilator
Without COVID, Medicare pays about $35K. With COVID, about 40K
Again, doctors aren& #39;t taking random deaths, calling them COVID deaths
That& #39;s fraud
9/10
So does COVID diagnosis get hospitals a little extra $?
Yes
Are physicians, hospitals lying about who has COVID?
No
Are people dying “with” COVID, not “because of” COVID?
Clinical nonsense
10/11
Yes
Are physicians, hospitals lying about who has COVID?
No
Are people dying “with” COVID, not “because of” COVID?
Clinical nonsense
10/11
So lets ignore the noise and misinformation about COVID billing, etc.
While doctors and nurses are dying on the front lines,
our leaders aren& #39;t working to get them protective equipment
Instead, they are falsely accusing our front line providers of fraud
Its reprehensible
While doctors and nurses are dying on the front lines,
our leaders aren& #39;t working to get them protective equipment
Instead, they are falsely accusing our front line providers of fraud
Its reprehensible
